ETASSUM39120 Specimenapplication Form for Schedule 3 SAYE Option Scheme

ETASSUM39120 Specimenapplication form for Schedule 3 SAYE option scheme

APPLICATION FORM*

Schedule 3 SAYE OPTION SCHEME

(the scheme)

PLEASE USE BLOCK CAPITALS AND READ THE ACCOMPANYING NOTES

To: The Secretary

Name1......

Address......

......

......

...... POST CODE ......

EMPLOYING COMPANY ......

A. APPLICATION FOR A SHARE OPTION

I apply for an option under the scheme to acquire ordinary shares of [ ] each in ……………………...... PLC/Ltd with the proceeds of a Sharesave contract and I agree to be bound by the rules of the scheme.2

I wish to exercise my option after ...... years.3

B. DEDUCTION FROM PAY

I authorise my employing company to deduct from my pay the amount shown below and to pay this amount to the ...... bank/building society/authorised European savings institution* until I have completed the equivalent of (....)4 months’ payments. I accept that this amount may be varied if I change from weekly to monthly pay or vice versa. These instructions remain in force until cancelled by me in writing.

C. AMENDMENTS

I authorise the company to change my election as necessary and/or reduce the amount shown above and below if the total number of shares applied for exceeds the number available.

D. APPLICATION FOR SHARESAVE CONTRACT

I hereby apply to enter the above-mentioned scheme with the ...... building society and I will authorise my employer, ......

to make appropriate periodical deductions from my pay so as to make

36monthly contributions of.....……...... 7

60 monthly contributions of……………...….7 & 8

to be credited to a Sharesave account with this society for investment under this scheme. The payments under this contract shall start not earlier than...... ……......

I have received a copy of the prospectus dated ………………… and accept the terms thereof. I apply to enter into membership of the society in respect of these shares, and I agree to be bound by its rules.

E. CONDITIONS

a)I declare that I am 16 years of age or more;

b)that I am eligible to participate in the Plan;

c)that this savings contract will not breach the £500 monthly savings limit as explained in the invitation and I understand that, if this declaration is untrue in any respect, any interest or bonus payable under this Plan will be forfeited.

d)I hereby declare that I am applying for an option on my own behalf.

Your signature is binding on both the application for an Option and the Savings Contract.

Signature6 ...... Date ......

*Delete as appropriate.

IMPORTANT. Your completed application form must reach the company by [ ]. Please allow at least three working days for delivery by post.

Notes for guidance on completion of the application form for an option

* For options granted after 17th July 2013.

Enter your full name and address in BLOCK CAPITALS.

2 A copy of the rules of the scheme may be inspected on application to [ ].

3 In order to calculate the number of shares over which you will be granted an option, you must decide whether you wish to exercise your option after three, or five years. Enter threeor five as you decide.

4 Enter 36 if you wish to save for three years and exercise your option after three years, or 60 if you wish to save for five years and exercise your option after five years.

5 COMPLETE ONE BOX ONLY. Decide how much you wish to save and enter the amount in the appropriate box. The first deductions will commence from your first pay shortly after the option is granted to you.

6 Sign and date.

7The amount to be entered here should be whole pounds (sterling) not less than £5 and not more than £500.

8 Where application is made for more than one contract, the level of combinations must not exceed £500 in aggregate.

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